Thanks for Supporting Kids

scheduled obstetric visits o r telling the underweight woman to drink more milk shakes are not effective interventions. I suggest that health care plans recognize the value of including referrals to a registered dietitian as part of routine pregnancy care, which, in turn, would benefit the health of future generations.

UAPs and Breastfeeding have enjoyed each new issue of Lifelines and commend you. As a Canadian perinatal nurse, I’m not currently working with UAPs, SO I appreciated Kathleen Rice Simpson’s excellent overview ( UAPs: What Nurses Need to Know, June 1997) of their impact on nursing practice. The sample activities for an “OB technician” enabled me to picture the role somewhat and I must take exception to the inclusion of “assisting the new mother with breastfeeding” in this list. Applying the framework suggested yields the following: 1. Potential for harm-far-reaching: the mother and baby may end up missing the many benefits of breastfeeding. 2. Complexity of the task-significant: physical, physiologic, psychosocial, and cultural factors all affect the process of learning to breastfeed. 3 . Are problem-solving and critical thinking required? Yes! 4. Unpredictability of outcomemajor: every mother-baby pair responds differently and learns to communicate at diferent rates. 5. The level of care-giver patient interaction-in-depth knowledge and expert communication skills are required to facilitate this important component of maternal role attainment. 6. The practice setting-complex and demanding: helping with breastfeeding is repetitive in that feedings should occur at least eight to ten times per 24 hours. Help can be offered skillfully as mother-to-mother support (e.g., via La Leche League). However, facilitating breastfeeding clearly requires nursing judgment on an LDRP unit. Please reconsider the complexity of the privilege of helping new mothers to breastfeed.

Maureen White, RN,MN, ZBCLC Halifax, Nova Scotia

Bolstering Birth Weight egarding “Examining Birth Weight, Later Health” (June 1997), certainly nurses can do much to help women understand the importance of healthful nutrition and appropriate weight gain in pregnancy. However, I would like to suggest that frequent consultations with a registered dietitian throughOut the pregnancy is even more valuable in helping the patient reach these goals. The registered dietitian can help the patient to improve eating

December 1997

behaviors, teach her to identify foods and portion sizes contributing to excessive caloric intake, and assume role-modeling behaviors that can extend to the nutritional health of each family member. Additionally, the pregnancy weight gain grid is an effective tool to share with the patient to help her understand the importance of the pattern of the expected weight gain. This helps her to see how she can avoid excessive weight gain by the end of pregnancy. Merely admonishing women for excessive weight gain between

Laura Loudemilk, RNC, CDE, MSN Chico, CA

Cleft Palates

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nna Alexander-Doelle’s personal experience in her response to the nurse looking for someone with firsthand experience with hreastfeeding babies with a cleft lip and/or palate was informative (“Conversations with Colleagues,” August 1997); however, she didn’t address her breastfeeding experience, and her ending sentence negates all the evidence of the advantages of breastfeeding and breastmilk for babies born with cleft lips and/or palates. The La Leche League International and the International Lactation Consultation Association are both great resources for breastfeeding babies with cleft lips or cleft palates. Also, Lactnet is an Internet breastfeeding discussion site for professionals to compile and disseminate information.

Linda Becklev, RN, BSN, IBCLC Mandan, N D

Thanks for Supporting Kids

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eepest thanks to you for your wonderful work on the Children’s Health Initiative in the budget agreement, which was signed into law in early August. The new law will give millions of children the healthy start in life they deserve. Only last December, opportunities for the millions of children withont health insurance appeared bleak. But in just seven months, we went from a modest $3.7 billion proposed investment to $48 billion over the next 10 years-the largest health funding expansion since Medicaid was enacted 30 years ago.

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Thanks to your hard work, and the work of thousands of concerned people across the country, millions of uninsured children in working families will now have access to affordable health coverage. We at the Children's Defense Fund look forward to continuing to work together to ensure every state implements a comprehensive, effective child health insurance program that reaches as many children as possible.

Mavgaret Wright Edelman Director, Childrenk Defense Fund Washington, DC For an update on this new law in action, read our Commentay on page 15. ,

Defining Jewish Traditions was excited to see one of the cover stories on the last issue of Lifelines regarding Jewish traditions surrounding pregnancy and birth (Keeping the Faith, August 1997);however, I was disappointed with the article. The author discriminates among orthodox, reform, and even nonpracticing Jews only one time, and the bulk of the article appears to address how to work with orthodox Jews. In fact, if an RN ordered a Kosher meal for me, assumed I had to cover my head, and that my hus-

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band couldn't touch me, I would be offended. Finally, the information regarding the naming is only partially true. Ashkenazic Jews don't tend to name their children after living relatives; however, Sephardic Jews do. The Torah isn't kept in homesrather it's an expensive, hand-written document kept in a synagogue. In closing, as a Jew, I was astonished at the author's attempt to characterize Jews as a cohesive religion, which is no more true than to say that all Christians d o this and all Christians think this way, eg., all Catholics eat fish on Fridays. By formalizing what Jews think, feel, and believe, the author fails in discussing Jewish traditions. I believe that a nurse can give thoughtful care for a Jewish family when she makes no assumptions about their needs and instead inquires with an open attitude.

Ami L. Goldstein, RN Durham, NC From the editor: We've received

you've shared with us in your letter regarding the Jewish traditions article. We would point out that the author does attempt to indicate early in the article that although all Jewish traditions stem from one source, not all Jews practice all traditions, and as such she encourages nurses to provide thoughtful care with regard to individual choices and preferences. As with any religious or cultural set of beliefs, views will range widely, and to accommodate the spectrum of opinion, Lifelines did seek the input of Jewish faith leaders on the text. As we continue to cover the cultural aspects of providing care, we'll be interested in hearing how you think

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W e ' d @OUG to hcxzfi &om you! Write: "Letters to the Editor," AWHONN lifelines, 700 14th St., N.W., Suite 600,Washington, DC 20005-2006; or E-mail us at [email protected].

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Lifelines

December 7997